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Pregnancy induced hypertension

What two things have to be present for diagnosis of PIH? High B/P, and Protein in urine
What are Risk factors for PIH? First pregnancy Age less than 20 and greater than 35 family hx obesity diabetes Multi fetal pregnancy- twins angiotensin Gene T235 Chronic hypertension or renal disease
What are the classic symptoms of PIH? High B/P >140/90 Protein in urine Edema above the waist (hands, face)
PIH Symptoms that effect Nervous system headache seizures drowsiness Brisk reflexes
PIH Symptoms that effect Ophthalmologic Visual disturbance- blurring, double vision, see spots
PIH Symptoms that effect Dermatologic Edema
PIH Symptoms that effect Cardiopulmonary Heart attack stroke
PIH Symptoms that effect Renal kidney disease decreased urinary output increased protein
PIH symptoms that effect gastrointestinal N/V upper right abdominal pain
PIH symptoms that effect Musculoskeletal pain
Patho for PIH Result of Vasospasm leaky vessels- from damage to cell lining in arterioles leaky vessels then cause the body to think it has lost fluid Kidneys then hold fluid - decreasing output which makes blood viscous and start spilling protein
Liver during PIH decrease flow during vasospasm causing damage or necrosis- not enough nutrients to baby
Brain during PIH has decreased flow causing hemorrhage in small capillaries
Placenta during PIH Has decreased flow during vasospasm...IUGR, abruption, hypoxia- cant get O2 to baby, can be emergency situation for baby
What lab work is used for diagnosis of PIH urine test- see if protein present CBC- looking for platelet chem with liver profile uric acid-see if kidneys working properly type& screen - to see if we need to replace blood
How can you tell if PIH is worsening? If symptoms become severe B/P 160/110 ect...
What is the top priority of Mom and baby with PIH? safety
What is the goal and cure of PIH? delivery of baby
How do you prevent PIH? Good prenatal care Medications and supplements have not been proven to prevent it NO CURE YET
What are the top Nursing interventions for PIH Hourly checks: Assess B/P , temp, pulse, RR (anything below 12) Monitor urine out put (want above 30) monitor weight gain Assess: reflexes (absent resp.arrest) for edema monitor consciousness Give mom Mag sulfate Give baby Steroids
When do you give steroids for baby? Anything before 34 wks gets steroids Anything after does not
Is vaginal delivery or c-section preferred? vaginal delivery C-section only for emergency situations
What is good and normal for urinary output? anything above 30cc/ hr
What medications are for PIH? magnesium sulfate Hydralazine Labetalol Nifedipine
Magnesium sulfate Used to prevent seizure NOT b/p med High alert- need 2 nurses to start
Hydralazine vasodilator
Labetalol beta blocker
Nifedipine calcium channel blocker
Mild PIH exhibit few if any symptoms b/p is 140/90 or higher 1+ proteinuria may occur liver enzymes may be elevated minimally edema may be present
Severe PIH Develop suddenly B/P 160/110 or higher on 2 occasions Proteinuria 5g or higher in 24 hr collection 3+ to 4+ on 2 random samples @ least 4hrs apart Oliguria is present Urine output equal or less to 500ml in 24 hrs
Other symptoms of severe PIH N/V irritability hyperreflexia retinal edema
HELLP Hemolysis- broken down RBC Elevated liver enzymes- very elevated Low platelets- very low, can have sig. bleed Serious complication
HELLP prominent symptoms upper right quad pain severe edema N/V mortality is high
HELLP sometimes complicated by? DIC ( Disseminating Intravascular Coagulopathy)- Body not able to coagulate blood w/ potential to hemorrhage -from anywhere , any opening
PIH is also known as Toxemia Preeclampsia
Created by: Jaycee420